Friday, August 26, 2005

Fighting Evidence with Evidence: Insurance companies are beginning to scruitinize the research studies used by pharmaceutical companies to promote their products:

As the cost of drugs in the U.S. approaches $250 billion a year, pharmaceutical companies are running up against a growing breed of detective trained to see through marketing spin. Working for insurers, state Medicaid programs and nonprofit bodies, these detectives cast a wary eye on published studies in medical journals, once considered an unimpeachable source. They search for subtle aspects of clinical-trial design that might show the drugs are not all they're cracked up to be.

"You could be duped," says Siri Childs, who oversees pharmacy policy for the Washington state Medicaid program. "We know now that just because it's published in a medical journal, that doesn't assure its quality."

Exactly. And you can't just read the abstract, either:

When Dr. Kubota started her current job in 1997, she says she "would just read the abstract," the summary at the beginning of a study. "I guess I was naive," she says. "You kind of assume everything is there for you in the abstract." Today, she quickly homes in on details that aren't mentioned in the abstract and generates a 6-inch stack of papers studded with Post-it notes for each drug.

Those are both lessons that I only learned about several years ago. It was Redux that pulled the blinders from my eyes. I never prescribed it, largely because I had read in the Medical Letter that there were reports of it causing serious heart problems in France. And yet, there an editorial in the New England Journal of Medicine sung its praises. That was confusing until it was later revealed that the editorials authors had financial ties to the company that made Redux. I've never taken another claim at face value again, no matter where it's published.

That's why the position of the American Medical Association is especially disheartening:

A resolution in June by the American Medical Association said some Medicaid programs were trying to cut costs and devalue doctors' judgment under the guise of "evidence-based medicine.